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Transparent criteria for specialist level adolescent psychiatric care

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Abstract

Background

Rising health care costs and long waiting lists pose a challenge to public specialist level health services. In Finland, the Ministry of Social Affairs and Health required all medical specialities to create a priority-rating tool for elective patients, preferably giving a numerical rating ranging 0–100, with 50 as an entry threshold.

Objective

To create and test the psychometric properties of a point-count measure for prioritising entry to public specialist level adolescent psychiatric services.

Method

Around 710 referred adolescents were given ratings on 17 items focusing on symptom severity, problem behaviours, functioning, progress of adolescent development and prognosis. The structured ratings were compared to an overall assessment of need for treatment on a VAS scale. In order to ensure that the tool was not inappropriately sensitive to confounding by non-disturbance related factors, the associations between the structured priority rating and sex, age, referring agent, study site and diagnosis were analysed.

Results

Of the 17 items, 15 were included in the final priority-rating tool. The requirement than threshold score for entry to services being set at 50 points necessitated scoring factors rather than individual items. Four blocks of items were formed: symptoms and risks; impaired functioning; other relevant issues, and prognosis without specialist level treatment. Most of the referred adolescents scored over the threshold of 50. When diagnosis was controlled for, scoring over 50 was largely independent of age, sex, referring agent or study site.

Conclusion

The structured priority ratings corresponded well with clinical global rating of need for care. The tool was not inappropriately sensitive to age, sex, referring agent or study site. In the future, follow-up studies will be needed to evaluate the predictive value of priority ratings.

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Authors and Affiliations

  1. Department of Adolescent Psychiatry, Tampere University Hospital, and Tampere School of Public Health, Tampere, Finland

    Riittakerttu Kaltiala-Heino MD

  2. Tampere School of Public Health, Tampere, Finland

    Sari Fröjd MSc & Ville Autio MSc

  3. Department of Adolescent Psychiatry, Kuopio University Hospital, Kuopio, Finland

    Eila Laukkanen MD

  4. Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland

    Pekka Närhi MD

  5. Adolescent Psychiatric Unit, Tampere University Hospital, Tampere, Finland

    Päivi Rantanen MD

  6. Psychiatric Treatment and Research Unit for Adolescent Intensive Care (EVA), Tampere University Hospital, 33380, Pitkäniemi, Finland

    Riittakerttu Kaltiala-Heino MD

Authors
  1. Riittakerttu Kaltiala-Heino MD
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  2. Sari Fröjd MSc
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  3. Ville Autio MSc
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  4. Eila Laukkanen MD
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  5. Pekka Närhi MD
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  6. Päivi Rantanen MD
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Corresponding author

Correspondence to Riittakerttu Kaltiala-Heino MD.

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Kaltiala-Heino, R., Fröjd, S., Autio, V. et al. Transparent criteria for specialist level adolescent psychiatric care. Eur Child Adolesc Psychiatry 16, 260–270 (2007). https://doi.org/10.1007/s00787-006-0598-4

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  • DOI: https://doi.org/10.1007/s00787-006-0598-4

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